目的 探讨妊娠早期正常高值血压与不良妊娠结局（APO）的关联。方法 采用队列研究，纳入2020年1月1日至2022年12月31日在深圳市妇幼保健院招募的妊娠早期（妊娠6~13⁺⁶周）37 998例单胎活产孕妇。收集孕妇一般资料、妊娠早期平均血压及APO等信息。依据《中国高血压防治指南（2024年修订版）》，将孕妇按妊娠早期平均血压分为：正常血压组[<120/80 mmHg（1 mmHg=0.133 kPa）]，正常高值组（120~139/80~89 mmHg）和高血压组（≥140/90 mmHg）。采用χ² 检验、多因素logistic回归、敏感度分析进行统计分析。结果 与正常血压组相比，正常高值组APO总体发生率更高（P<0.05）。多因素logistic回归分析显示，正常高值血压是妊娠期高血压[调整后比值比（aOR）=6.22，95%置信区间（CI） 4.99~7.76]、子痫前期（aOR=3.43，95%CI 2.85~4.13）的独立危险因素。排除孕中晚期发生妊娠期高血压或子痫前期的人群后，正常高值血压仍与妊娠期糖尿病（aOR=1.95，95%CI 1.42~2.67）、早产（aOR=1.17，95%CI 1.03~1.33）、小于胎龄儿（aOR=1.23，95%CI 1.11~1.44）的风险增加显著相关（P<0.05）。结论 妊娠早期血压水平与APO风险呈显著的剂量-反应关系。依据中国指南定义的“正常高值血压”是APO的独立危险因素。

Objective To investigate the association between high-normal blood pressure in the first trimester and adverse pregnancy outcomes （APO）. Methods This cohort study recruited singleton and live birth pregnancies in the first trimester （6-13⁺⁶ weeks of gestation） from Shenzhen Maternity and Child Healthcare Hospital Affiliated from January 1，2020 to December 31，2022.The general data，mean blood pressure in the first trimester and APO were collected. According to the 2024 Chinese Guidelines for the Management of Hypertension，participants were categorized based on mean blood pressure in the first trimester into three groups： normotensive pressure group[<120/80 mmHg（1 mmHg=0.133 kPa）]，high-normal blood pressure group （120-139/80-89 mmHg），and hypertension group （≥140/90 mmHg）. Statistical analyses were performed using the χ² test，multivariate logistic regression，and sensitivity analysis. Results Compared with the normotensive group，the high-normal blood pressure group had a significantly higher overall incidence of APO （P<0.05）. Multivariate logistic regression analysis showed that high-normal blood pressure was an independent risk factor for gestational hypertension （aOR=6.22，95%CI 4.99-7.76） and preeclampsia （aOR=3.43，95%CI 2.85-4.13）. After excluding the women who developed gestational hypertension or preeclampsia in the second or third trimester，high-normal blood pressure remained significantly associated with increased risks of gestational diabetes mellitus （aOR=1.95，95%CI 1.42-2.67），preterm birth （aOR=1.17，95%CI 1.03-1.33），and small for gestational age （aOR=1.23，95%CI 1.11-1.44） （P<0.05）. Conclusions There is a significant dose-response relationship between first-trimester blood pressure level and the risk of APO. High-normal blood pressure，as defined by the Chinese guidelines，is an independent risk factor for APO.