严重的孕产妇发病率与慢性高血压,妊娠前和妊娠高血压相关
Erica P Gunderson1,2, Mara Greenberg3, Michael Najem4
1Division of Research, Kaiser Permanente Northern California, Pleasanton.
JAMA network open
|January 28, 2025
概括
严重的孕产妇发病率 (SMM) 在孕前中最高,无论是否叠加于慢性高血压. 在慢性高血压患者中预防孕前是降低孕产妇发病率的关键.
科学领域:
- 产科和妇科 产科和妇科
- 孕产妇和胎儿医学 孕产妇和胎儿医学
- 怀孕期间的心血管健康
背景情况:
- 慢性高血压和孕前显著增加孕产妇和新生儿的风险.
- 现有的关于严重孕产妇发病率 (SMM) 的研究还没有充分排除先前存在的疾病,导致不复杂慢性高血压的具体风险不清楚.
研究的目的:
- 确定患有或没有慢性高血压的孕妇中SMM的发病率.
- 估计与不同妊娠高血压疾病相关的SMM的相对风险,不包括先前患有心脏,或肝脏疾病的人.
主要方法:
- 综合医疗保健系统的263518名孕妇的回顾性队列研究 (2009-2019).
- 电子健康记录的分析,不包括怀孕前心脏,或肝脏疾病的患者.
- 根据慢性高血压状态和怀孕期间高血压疾病的发展而分为五组.
- 使用CDC标准计算的SMM率;通过修改Poisson回归估计的相对风险.
主要成果:
- 在患有妊娠前 (934.3/10,000出生) 和妊娠前叠加于慢性高血压 (898.3/10,000出生) 的患者中观察到最高的SMM率.
- 妊娠高血压显示中等的SMM率 (312.7/10,000分娩).
- 患有慢性高血压但没有妊娠前的患者的SMM率 (195.1/10,000分娩) 与参考组 (165.8/10,000分娩) 类似.
- 与基准组相比,SMM的调整后的相对风险在慢性高血压与叠加的孕前 (aRR,4.97),没有孕前的慢性高血压 (aRR,5.12),没有孕前的慢性高血压 (aRR,1.17) 和妊娠高血压 (aRR,1.78) 中显著较高.
结论:
- 孕前,无论是叠加于慢性高血压还是没有,都具有SMM的最高风险.
- 孕期高血压与中等SMM率有关.
- 在没有并发症的慢性高血压患者中预防孕前对于减轻孕产妇发病率至关重要.
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