Pregnancy as a window to future health: maternal placental syndromes and short-term cardiovascular outcomes
Pregnancy as a window to future health: maternal placental syndromes and short-term cardiovascular outcomes
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DOI：
10.1016/j.ajog.2016.05.047
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发表时间：
2016-10-01
影响因子：
9.8
通讯作者：
Louis, Judette M.
中科院分区：
文献类型：
--
作者：
Cain, Mary Ashley;Salemi, Jason L.;Louis, Judette M.
背景：心血管疾病是女性死亡的主要原因。确定未来心血管疾病的危险因素可能会导致早期的生活方式改变和疾病预防。此外，心血管疾病的解释性发展可导致随后妊娠的围产期发病率增加。确定和实施短期干预措施（首次怀孕5年内）可能会降低随后怀孕的发病率。目的：我们确定了短期风险在经历过母体胎盘综合征以及早产和/或分娩小于胎龄儿的妇女中（首次妊娠5年内）心血管疾病的研究设计：我们使用基于人群的临床增强数据库对佛罗里达州的女性进行了回顾性队列研究。研究纳入了在研究期间首次分娩且无妊娠前糖尿病、高血压或心脏病或肾病病史的15-49岁未生育妇女和女孩。在第一次怀孕期间发生和未发生胎盘综合征的妇女中，比较了随后发生心血管疾病的风险。然后对胎盘综合征和早产或分娩小于胎龄儿的妇女与没有这些不良妊娠结局的妇女的风险进行了重新评估。每例患者的中位随访时间为4.9年。患有任何胎盘综合征的妇女和女孩随后患心血管疾病的未调整率（每1000名妇女中有11.8人）比没有胎盘综合征的妇女和女孩高出39%（每1000名妇女中有8.5人）。即使在调整了社会人口因素、先前存在的疾病以及与当前妊娠相关的临床和行为状况后，患有任何胎盘综合征的妇女和女孩患心血管疾病的风险增加了19%（风险比，1.19; 95%置信区间，1.07-1.32）。胎盘综合征> 1的妇女和女孩心血管疾病风险最高（风险比，1.43; 95%置信区间，1.20-1.70），其次是单独的子痫/先兆子痫（风险比，1.42; 95%置信区间，1.14-1.76）。当胎盘综合征合并早产和/或小于胎龄儿时，心血管疾病的校正风险增加45%（95%置信区间，1.24-1.71）。胎盘综合征的妇女和女孩，然后发展心血管疾病经历了5倍的增加，在后续的医疗保健相关的费用，相比那些谁没有发展心血管diseases.CONCLUSION：妇女和女孩经历胎盘综合征和早产或小于胎龄儿在随后的心血管疾病的风险增加，在短期随访。在产后期间识别和改善心血管疾病风险的策略可能会改善未来的心脏病结局。
BACKGROUND: Cardiovascular disease is the leading cause of death among women. Identifying risk factors for future cardiovascular disease may lead to earlier lifestyle modifications and disease prevention. Additionally, interpregnancy development of cardiovascular disease can lead to increased perinatal morbidity in subsequent pregnancies. Identification and implementation of interventions in the short term (within 5 years of first pregnancy) may decrease morbidity in subsequent pregnancies.OBJECTIVE: We identified the short-term risk (within 5 years of first pregnancy) of cardiovascular disease among women who experienced a maternal placental syndrome, as well as preterm birth and/or delivered a small-for-gestational-age infant.STUDY DESIGN: We conducted a retrospective cohort study using a population-based, clinically enhanced database of women in the state of Florida. Nulliparous women and girls aged 15-49 years experiencing their first delivery during the study time period with no prepregnancy history of diabetes mellitus, hypertension, or heart or renal disease were included in the study. The risk of subsequent cardiovascular disease was compared among women who did and did not experience a placental syndrome during their first pregnancy. Risk was then reassessed among women with placental syndrome and preterm birth or delivering a small-for-gestational-age infant vs those without these adverse pregnancy outcomes.RESULTS: The final study population was 302,686 women and girls. Median follow-up time for each patient was 4.9 years. The unadjusted rate of subsequent cardiovascular disease among women and girls with any placental syndrome (11.8 per 1000 women) was 39% higher than the rate among women and girls without a placental syndrome (8.5 per 1000 women). Even after adjusting for sociodemographic factors, preexisting conditions, and clinical and behavioral conditions associated with the current pregnancy, women and girls with any placental syndrome experienced a 19% increased risk of cardiovascular disease (hazard ratio, 1.19; 95% confidence interval, 1.07-1.32). Women and girls with > 1 placental syndrome had the highest cardiovascular disease risk (hazard ratio, 1.43; 95% confidence interval, 1.20-1.70), followed by those with eclampsia/preeclampsia alone (hazard ratio, 1.42; 95% confidence interval, 1.14-1.76). When placental syndrome was combined with preterm birth and/or small for gestational age, the adjusted risk of cardiovascular disease increased 45% (95% confidence interval, 1.24-1.71). Women and girls with placental syndrome who then developed cardiovascular disease experienced a 5-fold increase in health care-related costs during follow-up, compared to those who did not develop cardiovascular disease.CONCLUSION: Women and girls experiencing placental syndromes and preterm birth or small-for-gestational-age infant are at increased risk of subsequent cardiovascular disease in short-term follow-up. Strategies to identify and improve cardiovascular disease risk in the postpartum period may improve future heart disease outcomes.