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Special Issue: Current evidence and perspectives for hypertension management in Asia

Association of dynamic blood pressure trajectory during pregnancy with adverse birth outcomes: a large prospective cohort study in China

Hypertension Research (2026)Cite this article

Abstract

This study investigated the associations between dynamic blood pressure (BP) trajectories during pregnancy and adverse birth outcomes using data from the China-US Collaborative Project on Neural Tube Defect Prevention. Among 281,224 pregnant women (mean age 25.07 ± 3.57 years), group-based trajectory modeling (GBTM) identified three distinct systolic (SBP) and diastolic (DBP) BP patterns: “Low-stable”, “Fast-increasing”, and “High-stable”. Compared to the Low-stable SBP group, women with Fast-increasing or High-stable SBP trajectories had significantly elevated risks of adverse outcomes, including an 16% higher risk of preterm birth (adjusted OR = 1.16, 95% CI:1.09–1.23) and 37% increased risk of low birth weight (LBW) (aOR=1.37,1.27–1.49) in the High-stable group. For DBP, the Fast-increasing trajectory showed the strongest associations, with a 19% higher preterm birth risk (aOR=1.19,1.11–1.26) and 63% increased LBW risk (aOR=1.63,1.51–1.76). Each 10 mmHg rise in SBP and DBP from mid-to-late pregnancy was independently linked to higher risks of preterm birth (SBP: aOR=1.10,1.06–1.12; DBP: aOR=1.16,1.13–1.20) and low birth weight (SBP: aOR=1.12,1.09–1.14; DBP: aOR=1.22,1.18–1.26). These findings highlight that dynamic BP changes during pregnancy are robust predictors of adverse birth outcomes, underscoring the importance of continuous BP monitoring for early risk identification and intervention.

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Acknowledgements

We sincerely thank all participants and staff of this Cohort Study for their invaluable contributions to data collection and study implementation.

Funding

This work was supported by the Noncommunicable Chronic Diseases-National Science and Technology Major Project [Grant Number 2023ZD0508600].

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Authors and Affiliations

  1. Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China

    Wubulitalifu Dawuti, Mengmeng Li & Tao Huang

  2. Chinese Center for Diseases Control and Prevention, National Institute for Nutrition and Health, Beijing, China

    Jie Du

  3. Department of Epidemiology and Biostatistics, School of Public Health, Xinjiang medical University, Urumqi, China

    Xiaoli Tian

  4. School of Economics and Management, Beijing University of Technology, Beijing, China

    Bing Li

  5. Institute of Reproductive and Child Health, Peking University/Key Laboratory of Reproductive Health, National Health Commission of the People’s Republic of China, Beijing, China

    Yali Zhang, Weixian Gao & Zhiwen Li

  6. Key Laboratory of Molecular Cardiovascular Sciences (Peking University), Ministry of Education, Beijing, China

    Tao Huang

  7. Center for Intelligent Public Health, Academy for Artificial Intelligence, Peking University, Beijing, China

    Tao Huang

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  1. Wubulitalifu Dawuti
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Dawuti, W., Du, J., Tian, X. et al. Association of dynamic blood pressure trajectory during pregnancy with adverse birth outcomes: a large prospective cohort study in China. Hypertens Res (2026). https://doi.org/10.1038/s41440-026-02615-7

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