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Open Access 01-12-2019 | Research article

Trends of blood pressure and heart rate in normal pregnancies: a systematic review and meta-analysis

Authors: Lise Loerup, Rebecca M. Pullon, Jacqueline Birks, Susannah Fleming, Lucy H. Mackillop, Stephen Gerry, Peter J. Watkinson

Published in: BMC Medicine | Issue 1/2019

Abstract

Background

Current reference ranges for blood pressure and heart rate throughout pregnancy have a poor evidence base.

Methods

This is a systematic review and meta-analysis. We included studies measuring blood pressure or heart rate from healthy pregnant women within defined gestational periods of 16 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 in 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.

Study registration

PROSPERO CRD42014009673

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Title: Trends of blood pressure and heart rate in normal pregnancies: a systematic review and meta-analysis
Authors: Lise Loerup
Rebecca M. Pullon
Jacqueline Birks
Susannah Fleming
Lucy H. Mackillop
Stephen Gerry
Peter J. Watkinson
Publication date: 01-12-2019
Publisher: BioMed Central
Published in: BMC Medicine / Issue 1/2019
Electronic ISSN: 1741-7015
DOI: https://doi.org/10.1186/s12916-019-1399-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Trends of blood pressure and heart rate in normal pregnancies: a systematic review and meta-analysis

Abstract

Background

Methods

Results

Conclusions

Study registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Study registration

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