BACKGROUND Evidence of placental maternal vascular malperfusion is associated with significant perinatal outcomes such as preeclampsia, intrauterine growth restriction and preterm birth. Elevations in pre-pregnancy blood pressure increase the risk for poor perinatal outcomes; however, the evidence linking pre-pregnancy blood pressure and placental malperfusion is sparse. MATERIALS AND METHODS We conducted a retrospective case-control study of women with singleton gestations with placental evaluations who delivered at Magee-Womens Hospital in 2012. Charts from 100 deliveries with placental malperfusion lesions (vasculopathy, advanced villous maturation, infarct, or fibrin deposition) and 102 deliveries without placental malperfusion were randomly selected for screening. Blood pressure, demographic, and clinical data were abstracted from pre-pregnancy electronic medical records and compared between women with and without subsequent placental malperfusion lesions. RESULTS Overall, 48% of women had pre-pregnancy records, and these were similarly available for women with and without placental malperfusion. Women with placental malperfusion demonstrated a reduction in their pre- to early pregnancy decrease in diastolic blood pressure (DBP). Adjusted for race, pre-pregnancy BMI, age, pre-conception interval, and gestational age at the first prenatal visit, the difference in pre- to early pregnancy DBP was significantly less in women with placental malperfusion compared to those without this pathologic finding (- 1.35 mmHg drop vs - 5.6mmg, p < 0.05). CONCLUSION A blunted early gestation drop in DBP may be a risk factor for placental malperfusion, perhaps related to early pregnancy vascular maladaptation. The ability of the electronic medical record to provide pre-pregnancy data serves as an underutilized approach to study pre-pregnancy health.

中文翻译：

---

孕前血压和胎盘灌注不足的证据。

背景技术胎盘孕产妇血管灌注不良的证据与围产期的重要结局有关，如先兆子痫，子宫内生长受限和早产。孕前血压升高会增加围产期预后不良的风险；但是，孕前血压与胎盘灌注不足有关的证据很少。材料和方法我们对2012年在Magee-Womens医院分娩的单胎妊娠妇女进行了胎盘评估，进行了一项回顾性病例对照研究。图表显示了100例胎盘灌注不良（血管病，晚期绒毛成熟，梗塞或纤维蛋白沉积）的孕妇。随机选择102例无胎盘灌注异常的分娩筛查。血压，人口统计，并从怀孕前的电子病历中提取临床数据，并在有或没有随后胎盘灌注异常的女性之间进行比较。结果总体上，有48％的妇女有孕前记录，无论有无胎盘灌注异常的妇女，这些记录都是相似的。胎盘灌流不足的妇女表现出妊娠前至早期的舒张压（DBP）降低。在对种族，怀孕前的BMI，年龄，受孕前的间隔以及第一次产前检查时的胎龄进行校正后，胎盘灌流不足的女性与没有此病理发现的女性相比，妊娠前DBP的差异显着较小（ -1.35 mmHg下降vs-5.6mmg，p <0.05）。结论DBP的早期妊娠下降可能是胎盘灌流不良的危险因素，可能与妊娠早期血管适应不良有关。电子病历提供孕前数据的能力成为研究孕前健康状况的未充分利用的方法。