胎盘断裂,早产和心血管疾病在双胞胎后代
Rachel Lee1, Emily B Rosenfeld1,2, Linda Valeri3,4
1Division of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology, and Reproductive Sciences Rutgers Robert Wood Johnson Medical School New Brunswick NJ.
Journal of the American Heart Association
|March 10, 2026
概括
胎盘断裂显著增加了双胞胎后代的心血管疾病 (CVD) 的风险,早产中介了这一风险的很大一部分. 优化双胞胎怀孕的产科护理可能会减少子女未来的心血管疾病.
科学领域:
- 产科和妇科 产科和妇科
- 心血管流行病学心血管流行病学
- 围产儿医学 围产儿医学
背景情况:
- 妊娠并发症,包括胎盘断裂,与后代心血管疾病 (CVD) 风险增加有关.
- 与单独怀孕相比,双胞胎怀孕的并发症和心血管疾病风险更高.
- 胎盘断裂和双胞胎后代的非致命心血管疾病之间的特定关联以及早产的作用仍然不清楚.
研究的目的:
- 调查胎盘断裂与双胞胎后代发生的非致命心血管疾病 (CVD) 之间的关联.
- 确定早产是否调解胎盘断裂与双胞胎心血管疾病风险之间的关系.
主要方法:
- 利用PACER后代队列,将新泽西州 (1993-2020) 的双胞胎出生与住院和死亡记录联系起来.
- 采用考克斯模型来估计断裂对心血管疾病风险的直接和间接影响,并以早产为媒介.
- 分析了116,796名双胞胎的出生情况,重点是胎盘断裂和没有胎盘断裂的双胞胎.
主要成果:
- 胎盘断裂发生在2.2%的双胞胎出生中,并且与后代患心血管疾病风险增加2.47倍有关.
- 发生心血管疾病的发生率在暴露于断裂的后代中显著更高 (每10万人年有1560人与577人).
- 大约40%的断裂-心血管疾病相关性是由早产 (<37周) 介导的,在较早的妊娠年龄中介作用增加.
结论:
- 胎盘断裂是双胞胎后代到成年早期心血管疾病风险较高的重要危险因素.
- 过早分娩在很大程度上调解了与双胞胎胎胎盘断相关的心血管疾病风险增加.
- 改善产科护理以减少双胞胎怀孕中的胎盘断裂,可以通过降低后代心血管疾病率来产生公共卫生效益.
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