{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T22:47:16Z","timestamp":1785883636138,"version":"3.56.0"},"reference-count":13,"publisher":"Springer Science and Business Media LLC","issue":"8","license":[{"start":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T00:00:00Z","timestamp":1781568000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T00:00:00Z","timestamp":1781568000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Hypertens Res"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Management of chronic hypertension in pregnancy remains uncertain, and current guidelines do not address whether the prognostic significance of blood pressure (BP) varies across gestation. To evaluate gestational age\u2013specific associations between maternal BP in the first half of pregnancy and adverse maternal and neonatal outcomes. We conducted a multicenter registry-based cohort study from April 2022 to March 2023 at 65 tertiary referral centers in Japan. A total of 273 women with chronic hypertension and singleton pregnancies were enrolled before 14 weeks\u2019 gestation (median age, 37 years; IQR, 34\u201340). Systolic and diastolic BP were assessed at three gestational windows (8\u20139, 10\u201313, and 14\u201318 weeks). Aspirin exposure was treated as time-dependent. The primary outcome was a composite of adverse maternal and neonatal events. Cox proportional hazards models and restricted cubic spline analyses were used. Adverse outcomes occurred in 32.6% (89\/273). BP\u2013risk associations differed by timing. No association was observed at 8\u20139 weeks. At 10\u201313 weeks, risk increased progressively with higher systolic BP, including excess risk in the moderate range (120\u2013134\u2009mmHg) and the highest risk at \u2265135\u2009mmHg (HR, 4.11; 95% CI, 1.14\u201314.82). At 14\u201318 weeks, a threshold pattern emerged, with increased risk above 140\u2009mmHg (HR, 2.19; 95% CI, 1.40\u20133.43). Associations were weaker among women who initiated aspirin before 10 weeks, although interaction was not statistically significant. In chronic hypertension, maternal BP during 10\u201313 weeks of gestation carries heightened prognostic relevance. These findings support gestational age\u2013specific risk assessment and motivate evaluation of early preventive strategies.<\/jats:p>","DOI":"10.1038\/s41440-026-02710-9","type":"journal-article","created":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T07:27:25Z","timestamp":1781594845000},"page":"2377-2385","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Gestational ages\u2013specific blood pressure patterns and risk of adverse pregnancy outcomes in women with chronic hypertension"],"prefix":"10.1038","volume":"49","author":[{"given":"Munekage","family":"Yamaguchi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Morinaga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akihito","family":"Sagara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshinori","family":"Yamanouchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Azusa","family":"Miyashita","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eiji","family":"Kondoh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,16]]},"reference":[{"key":"2710_CR1","doi-asserted-by":"publisher","first-page":"1716","DOI":"10.1161\/HYPERTENSIONAHA.124.22731","volume":"81","author":"SA Leonard","year":"2024","unstructured":"Leonard SA, Siadat S, Main EK, Huybrechts KF, El-Sayed YY, Hlatky MA, et al. Chronic Hypertension During Pregnancy: Prevalence and Treatment in the United States, 2008-2021. Hypertension. 2024;81:1716\u201323.","journal-title":"Hypertension"},{"key":"2710_CR2","doi-asserted-by":"publisher","first-page":"134.e1","DOI":"10.1016\/j.ajog.2011.10.878","volume":"206","author":"BT Bateman","year":"2012","unstructured":"Bateman BT, Bansil P, Hernandez-Diaz S, Mhyre JM, Callaghan WM, Kuklina EV. Prevalence, trends, and outcomes of chronic hypertension: a nationwide sample of delivery admissions. Am J Obstet Gynecol. 2012;206:134.e1\u20138.","journal-title":"Am J Obstet Gynecol"},{"key":"2710_CR3","doi-asserted-by":"crossref","first-page":"1122","DOI":"10.1097\/01.AOG.0000437382.03963.88","volume":"122","author":"American College of Obstetricians and Gynecologists","year":"2013","unstructured":"American College of Obstetricians and Gynecologists. Hypertension in pregnancy: report of the American College of Obstetricians and Gynecologists\u2019 Task Force on Hypertension in Pregnancy. Obstet Gynecol. 2013;122:1122\u201331.","journal-title":"Obstet Gynecol"},{"key":"2710_CR4","doi-asserted-by":"publisher","first-page":"e26","DOI":"10.1097\/AOG.0000000000003020","volume":"133","author":"American College of Obstetricians and Gynecologists\u2019 Committee on Practice Bulletins \u2014 Obstetrics","year":"2019","unstructured":"American College of Obstetricians and Gynecologists\u2019 Committee on Practice Bulletins \u2014 Obstetrics. ACOG practice bulletin no. 203: chronic hypertension in pregnancy. Obstet Gynecol. 2019;133:e26\u2013e50.","journal-title":"Obstet Gynecol"},{"key":"2710_CR5","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1161\/HYPERTENSIONAHA.117.10803","volume":"72","author":"MA Brown","year":"2018","unstructured":"Brown MA, Magee LA, Kenny LC, Karumanchi SA, McCarthy FP, Saito S, et al. Hypertensive disorders of pregnancy: ISSHP classification, diagnosis, and management recommendations for international practice. Hypertension. 2018;72:24\u201343.","journal-title":"Hypertension"},{"key":"2710_CR6","unstructured":"National Institute for Health and Care Excellence. Hypertension in pregnancy: diagnosis and management. 2019. https:\/\/www.nice.org.uk\/guidance\/ng133. Accessed 30 November 2025."},{"key":"2710_CR7","doi-asserted-by":"publisher","first-page":"1781","DOI":"10.1056\/NEJMoa2201295","volume":"386","author":"AT Tita","year":"2022","unstructured":"Tita AT, Szychowski JM, Boggess K, Dugoff L, Sibai B, Lawrence K, et al. Chronic Hypertension and Pregnancy (CHAP) Trial Consortium. Treatment for Mild Chronic Hypertension during Pregnancy. N Engl J Med. 2022;386:1781\u201392.","journal-title":"N Engl J Med"},{"key":"2710_CR8","doi-asserted-by":"publisher","first-page":"1395","DOI":"10.1097\/AOG.0000000000005410","volume":"142","author":"EJ Bailey","year":"2023","unstructured":"Bailey EJ, Tita ATN, Leach J, Boggess K, Dugoff L, Sibai B, et al. Perinatal Outcomes Associated With Management of Stage 1 Hypertension. Obstet Gynecol. 2023;142:1395\u2013404.","journal-title":"Obstet Gynecol"},{"key":"2710_CR9","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1038\/s41440-021-00763-6","volume":"45","author":"A Ueda","year":"2022","unstructured":"Ueda A, Hasegawa M, Matsumura N, Sato H, Kosaka K, Abiko K, et al. Lower systolic blood pressure levels in early pregnancy are associated with a decreased risk of early-onset superimposed preeclampsia in women with chronic hypertension: a multicenter retrospective study. Hypertens Res. 2022;45:135\u201345.","journal-title":"Hypertens Res"},{"key":"2710_CR10","doi-asserted-by":"publisher","first-page":"473","DOI":"10.1016\/j.placenta.2009.02.009","volume":"30","author":"GJ Burton","year":"2009","unstructured":"Burton GJ, Woods AW, Jauniaux E, Kingdom JC. Rheological and physiological consequences of conversion of the maternal spiral arteries for uteroplacental blood flow during human pregnancy. Placenta. 2009;30:473\u201382.","journal-title":"Placenta"},{"key":"2710_CR11","doi-asserted-by":"publisher","first-page":"S745","DOI":"10.1016\/j.ajog.2017.11.577","volume":"218","author":"GJ Burton","year":"2018","unstructured":"Burton GJ, Jauniaux E. Pathophysiology of placental-derived fetal growth restriction. 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Am J Obstet Gynecol. 2020;223:419.e1\u2013419.e16.","journal-title":"Am J Obstet Gynecol"}],"container-title":["Hypertension Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41440-026-02710-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41440-026-02710-9","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41440-026-02710-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T22:05:15Z","timestamp":1785881115000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41440-026-02710-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,16]]},"references-count":13,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["2710"],"URL":"https:\/\/doi.org\/10.1038\/s41440-026-02710-9","relation":{},"ISSN":["0916-9636","1348-4214"],"issn-type":[{"value":"0916-9636","type":"print"},{"value":"1348-4214","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,16]]},"assertion":[{"value":"2 December 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 May 2026","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 June 2026","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 June 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}}]}}