The Impact of Small for Gestational Age Births in Early and Late Preeclamptic Pregnancies for Preeclampsia Recurrence: a Cohort Study of Successive Pregnancies in Sweden
The Impact of Small for Gestational Age Births in Early and Late Preeclamptic Pregnancies for Preeclampsia Recurrence: a Cohort Study of Successive Pregnancies in Sweden
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DOI：
10.1111/ppe.12317
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发表时间：
2016-11-01
影响因子：
2.8
通讯作者：
Johansson, Kari
中科院分区：
文献类型：
--
作者：
Cnattingius, Sven;Wikstrom, Anna-Karin;Johansson, Kari
背景：子宫动脉多普勒检查结果表明，与不伴胎儿生长受限的晚期子痫前期相比，伴胎儿生长受限的晚期子痫前期的病因可能与早期子痫前期的病因更为相似。我们假设，晚期子痫前期妊娠中的小于胎龄（SGA）出生可能与随后发生早期子痫前期的风险增加有关。我们还研究了母体因素对先兆子痫复发风险的影响。方法：在瑞典全国范围内对 1992 年至 2012 年间第一和第二个连续单胎出生的队列研究中，我们确定了 22 473 名母亲在第一次怀孕时患有先兆子痫。我们计算了相对风险 (RR) 和 95% 置信区间 (CI)，以调查第一次妊娠中子痫前期亚型与第二次妊娠中早期（= 34 周）先兆子痫风险之间的关联。结果：在既往患有晚期先兆子痫的女性中，同时发生的 SGA 出生与随后早期先兆子痫的风险增加相关（调整后的 RR 2.85，95% CI 1.93， 4.20），但不适用于随后的晚期先兆子痫。在既往患有早期子痫前期的女性中，同时发生的 SGA 出生与随后发生早期或晚期子痫前期的风险增加无关。妊娠间体重增加与第二次妊娠发生早期和晚期子痫前期的风险增加有关。结论：晚期子痫前期合并胎儿生长受限可能被视为缺血性胎盘疾病。鉴于先兆子痫复发的绝对风险很高，预防体重增加对于既往患有先兆子痫的女性尤其重要。
Background: Results from uterine artery Doppler investigations suggest that the aetiology of late preeclampsia with fetal growth restriction may be more similar to the aetiology of early preeclampsia than with late preeclampsia without fetal growth restriction. We hypothesised that a small-for-gestational-age (SGA) birth in a late preeclamptic pregnancy may be associated with increased subsequent risk of early preeclampsia. We also studied effects of maternal factors on risks of preeclampsia recurrence.Methods: In a nation-wide Swedish cohort study of first and second consecutive single births between 1992 and 2012, we identified 22 473 mothers with preeclampsia in their first pregnancy. We calculated relative risks (RR), and 95% confidence intervals (CI), to investigate associations between subtypes of preeclampsia in the first pregnancy and risks of early (= 34 weeks) preeclampsia in the second pregnancy.Results: In women with a previous late preeclampsia, a co-occurring SGA birth was associated with an increased risk of subsequent early preeclampsia (adjusted RR 2.85, 95% CI 1.93, 4.20), but not of subsequent late preeclampsia. Among women with a previous early preeclampsia, a co-occurring SGA birth was not associated with increased subsequent risks of early or late preeclampsia. Interpregnancy weight gain was associated with increased risks of early and late preeclampsia in the second pregnancy.Conclusions: Late preeclampsia combined with fetal growth restriction may be regarded as an ischaemic placental disease. Given the high absolute risk of preeclampsia recurrence, preventing weight gain may be especially important in women with previous preeclampsia.