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Ambulatory Blood Pressure Trajectory and Perceived Stress in Relation to Birth Outcomes in Healthy Pregnant Adolescents

Spicer, Julie, PhD; Giesbrecht, Gerald F., PhD; Aboelela, Sally, PhD; Lee, Seonjoo, PhD; Liu, Grace, MA; Monk, Catherine, PhD

doi: 10.1097/PSY.0000000000000698

Objective An early decline in resting blood pressure (BP), followed by an upward climb, is well documented and indicative of a healthy pregnancy course. Although BP is considered both an effector of stress and a clinically meaningful measurement in pregnancy, little is known about its trajectory in association with birth outcomes compared with other stress effectors. The current prospective longitudinal study examined BP trajectory and perceived stress in association with birth outcomes (gestational age (GA) at birth and birth weight (BW) percentile corrected for GA) in pregnant adolescents, a group at risk for stress-associated poor birth outcomes.

Methods Healthy pregnant nulliparous adolescents (n = 139) were followed from early pregnancy through birth. At three time points (13–16, 24–27, and 34–37 gestational weeks ±1 week), the Perceived Stress Scale was collected along with 24-hour ambulatory BP (systolic and diastolic) and electronic diary reporting of posture. GA at birth and BW were abstracted from medical records.

Results After adjustment for posture and pre-pregnancy body mass index, hierarchical mixed-model linear regression showed the expected early decline (B = −0.18, p = .023) and then increase (B = 0.01, p < .001) of diastolic BP approximating a U-shape; however, systolic BP displayed only an increase (B = 0.01, p = .010). In addition, the models indicated a stronger systolic and diastolic BP U-shape for early GA at birth and lower BW percentile and an inverted U-shape for late GA at birth and higher BW percentile. No effects of perceived stress were observed.

Conclusions These results replicate the pregnancy BP trajectory from previous studies of adults and indicate that the degree to which the trajectory emerges in adolescence may be associated with variation in birth outcomes, with a moderate U-shape indicating the healthiest outcomes.

From the Department of Psychiatry (Spicer), Icahn School of Medicine at Mount Sinai; Departments of Pediatrics & Community Health Sciences (Giesbrecht), University of Calgary, Alberta, Canada; Departments of Nursing (Aboelela), Psychiatry (Lee, Liu, Monk), and Obstetrics and Gynecology (Monk), Columbia University; and New York State Psychiatric Institute (Monk), New York.

Address correspondence to Julie Spicer, PhD, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1230, New York, NY 10029-6574. E-mail:

Received for publication October 26, 2018; revision received February 26, 2019.

Online date: April 18, 2019

Copyright © 2019 by American Psychosomatic Society
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