Hypertensive Pregnancy Disorders and Subsequent Cardiovascular Morbidity and Type 2 Diabetes Mellitus in the Mother
Hypertensive Pregnancy Disorders and Subsequent Cardiovascular Morbidity and Type 2 Diabetes Mellitus in the Mother
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DOI：
10.1161/hypertensionaha.109.130765
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发表时间：
2009-06-01
期刊：
影响因子：
8.3
通讯作者：
Paidas, Michael J.
中科院分区：
文献类型：
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作者：
Lykke, Jacob A.;Langhoff-Roos, Jens;Paidas, Michael J.
关于高血压妊娠障碍与随后的各种心血管事件之间的关系以及2型糖尿病对这些事件的影响的数据很少。在一项基于登记的队列研究中，我们确定了1978年至2007年在丹麦分娩的首次单胎妇女（n = 782 287）和连续两次首次单胎分娩的妇女（n = 536 419）。暴露是妊娠期高血压和轻度和重度先兆子痫。我们调整了早产、胎龄小、胎盘早剥和死胎，在第二个模型中，我们还调整了2型糖尿病的发展。终点是随后的高血压、缺血性心脏病、充血性心力衰竭、血栓栓塞事件、中风和2型糖尿病。妊娠期高血压后继发高血压的风险增加5.31倍（范围：4.90 ~ 5.75），轻度子痫前期增加3.61倍（范围：3.43 ~ 3.80），重度子痫前期增加6.07倍（范围：5.45 ~ 6.77）。妊娠期高血压后发生2型糖尿病的风险增加3.12倍（范围：2.63 ~ 3.70），重度子痫前期后增加3.68倍（范围：3.04 ~ 4.46）。两次妊娠均伴有先兆子痫的妇女随后高血压的风险增加了6.00倍（范围：5.40至6.67），而第一次妊娠伴有先兆子痫的妇女随后高血压的风险增加了2.70倍（范围：2.51至2.90），第二次妊娠伴有先兆子痫的妇女随后高血压的风险增加了4.34倍（范围：3.98至4.74）。妊娠期高血压和轻度和重度先兆子痫后发生血栓栓塞的风险分别增加1.03倍（范围：0.73 ~ 1.45）、1.53倍（范围：1.32 ~ 1.77）和1.91倍（范围：1.35 ~ 2.70）。因此，高血压妊娠障碍与随后的2型糖尿病和高血压密切相关，后者独立于随后的2型糖尿病。这些妊娠高血压疾病的严重程度、胎次和复发增加了随后发生心血管事件的风险。（高血压，2009;53:944-951）
Minimal data exist concerning the relationship between hypertensive pregnancy disorders and various subsequent cardiovascular events and the effect of type 2 diabetes mellitus on these. In a registry-based cohort study, we identified women delivering in Denmark from 1978 to 2007 with a first singleton (n = 782 287) and 2 first consecutive singleton deliveries (n = 536 419). The exposures were gestational hypertension and mild and severe preeclampsia. We adjusted for preterm delivery, small for gestational age, placental abruption, and stillbirth and, in a second model, we also adjusted for the development of type 2 diabetes mellitus. The end points were subsequent hypertension, ischemic heart disease, congestive heart failure, thromboembolic event, stroke, and type 2 diabetes mellitus. The risk of subsequent hypertension was increased 5.31-fold (range: 4.90 to 5.75) after gestational hypertension, 3.61-fold (range: 3.43 to 3.80) after mild preeclampsia, and 6.07-fold (range: 5.45 to 6.77) after severe preeclampsia. The risk of subsequent type 2 diabetes mellitus was increased 3.12-fold (range: 2.63 to 3.70) after gestational hypertension and 3.68-fold (range: 3.04 to 4.46) after severe preeclampsia. Women having 2 pregnancies both complicated by preeclampsia had a 6.00-fold (range: 5.40 to 6.67) increased risk of subsequent hypertension compared with 2.70-fold (range: 2.51 to 2.90) for women having preeclampsia in their first pregnancy only and 4.34-fold (range: 3.98 to 4.74) for women having preeclampsia in their second pregnancy only. The risk of subsequent thromboembolism was 1.03-fold (range: 0.73 to 1.45), 1.53-fold (range: 1.32 to 1.77), and 1.91-fold (range: 1.35 to 2.70) increased after gestational hypertension and mild and severe preeclampsia, respectively. Thus, hypertensive pregnancy disorders are strongly associated with subsequent type 2 diabetes mellitus and hypertension, the latter independent of subsequent type 2 diabetes mellitus. The severity, parity, and recurrence of these hypertensive pregnancy disorders increase the risk of subsequent cardiovascular events. (Hypertension. 2009; 53: 944-951.)