Risk factors for preeclampsia, abruptio placentae, and adverse neonatal outcomes among women with chronic hypertension
Risk factors for preeclampsia, abruptio placentae, and adverse neonatal outcomes among women with chronic hypertension
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DOI：
10.1056/nejm199809033391004
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发表时间：
1998-09-03
影响因子：
158.5
通讯作者：
Dombrowski, M
中科院分区：
文献类型：
--
作者：
Sibai, BM;Lindheimer, M;Dombrowski, M
患有慢性高血压的背景女性患有先兆子痫和不良新生儿结局的风险增加。但是，在该组中，这些不良事件的危险因素尚不清楚。我们分析了在低剂量阿司匹林的多中心试验中以预防先兆子痫的多中心试验，分析了763名慢性高血压女性的结果数据。先兆子痫的定义为在基础线上没有蛋白尿的682名女性中，新的蛋白尿（尿蛋白排泄，大于或等于每24小时300 mg）。它是根据在基线有蛋白尿的81名妇女中根据严格的临床标准定义的。终点是孕产妇和新生儿的结局。在763名女性中，193名（25％）患有先兆子痫。先兆子痫的频率不受基本蛋白尿存在的影响（蛋白尿女性为27％，而没有蛋白尿的女性为25％），但在患有高血压至少四年的女性中，蛋白尿的频率更大（31例百分比为22％，赔率为1.6；置信区间为1.1至2.2比率为1.6; 95％的置信区间，1.1至2.3）。基本蛋白尿的女性在妊娠不到35周的时间（36％比16％;几率比率为3.1; 95％的置信区间，1.8至5.3）的可能性明显更大。对于胎龄（23％比10％；几率比率，2.8; 95％的置信区间，1.6至5.0）。患有慢性高血压的女性的结论，存在妊娠早期蛋白尿与新生儿不良结局有关，独立于先兆子痫的发展。 （N Engl J Med 1998; 339：667-71。）（c）1998，马萨诸塞州医学会。
Background Women with chronic hypertension who become pregnant have an increased risk of preeclampsia and adverse neonatal outcomes. However, within this group, the risk factors for these adverse events are not known.Methods We analyzed data on outcomes for 763 women with chronic hypertension enrolled in a multicenter trial of low-dose aspirin for the prevention of preeclampsia. Preeclampsia was defined as new-onset proteinuria (urinary protein excretion, greater than or equal to 300 mg per 24 hours) in the 682 women without proteinuria at base line. it was defined according to strict clinical criteria in the 81 women who had proteinuria at base line. The end points were maternal and neonatal outcomes.Results Among the 763 women, 193 (25 percent) had preeclampsia. The frequency of preeclampsia was not affected by the presence of proteinuria at base line (27 percent among women with proteinuria, vs. 25 percent among those without it), but it was greater in women who had had hypertension for at least four years (31 percent vs. 22 percent; odds ratio, 1.6; 95 percent confidence interval, 1.1 to 2.2) and in those with preeclampsia during a previous pregnancy (32 percent vs. 23 percent; odds ratio, 1.6; 95 percent confidence interval, 1.1 to 2.3). Women with proteinuria at base line were significantly more likely to deliver their babies at less than 35 weeks of gestation (36 percent vs. 16 percent; odds ratio, 3.1; 95 percent confidence interval, 1.8 to 5.3) and to have infants that were small for gestational age (23 percent vs. 10 percent; odds ratio, 2.8; 95 percent confidence interval, 1.6 to 5.0).Conclusions In women with chronic hypertension, the presence of proteinuria early in pregnancy is associated with adverse neonatal outcomes independently of the development of preeclampsia. (N Engl J Med 1998;339:667-71.) (C)1998, Massachusetts Medical Society.