Is pre-eclampsia more than one disease?
Is pre-eclampsia more than one disease?
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DOI：
10.1111/j.1471-0528.2004.00071.x
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发表时间：
2004-04-01
影响因子：
5.8
通讯作者：
Skjærven, R
中科院分区：
文献类型：
--
作者：
Vatten, LJ;Skjærven, R
目的子痫前期的临床特征(妊娠期高血压和蛋白尿)可能代表不同的发病条件。先兆子痫伴胎儿生长受限可能源于植入异常，适当或过高的出生体重可能意味着多种疾病的混合，从轻度先兆子痫伴轻度胎盘受累到高血压无胎盘疾病。设计前瞻性、观察性研究。设置一般人群。人口我们使用挪威医学出生登记处的数据，这是一个基于人口的登记，自1967年以来一直记录出生人数。在这项研究中，我们使用了1967至1998年间出生的1,679,205名单身人士的妊娠长度和先兆子痫的存在情况。在44,220(2.6%)名孕妇中被诊断为先兆子痫。方法我们研究了出生体重标准化测量(z分数)与先兆子痫风险的关系，调整了孕期长度，并按足月和早产进行分层。我们还探讨了妊娠期糖尿病合并早产儿是否比足月先兆子痫更普遍。主要结局衡量的是早产儿或早产儿确诊的先兆子痫。结果对于在足月前后确诊的先兆子痫，出生体重与出生体重呈U型相关。与适合妊娠的出生体重相比，如果婴儿的出生体重低于平均值下的两个标准差，则足月先兆子痫的风险高出四倍以上(相对风险[RR]4.5，95%可信区间[CI]4.3至4.7)。对于出生体重三个标准差或高于平均值，先兆子痫的可能性是平均值的两倍多(RR 2.6，95%CI 2.2-2.9)。相比之下，早产儿先兆子痫的风险与出生体重呈L式关联。低出生体重(小于-2个标准差)与风险的显著增加相关(RR 9.9，95%CI 9.1-10.9)，但对于高出生体重(大于或等于3个标准差)，与早产先兆子痫的风险无关(RR 1.2，95%CI 0.7-2.1)。早产儿妊娠期糖尿病的患病率是足月先兆子痫的3倍(患病率3.3，95%可信区间2.6~3.6)。结论先兆子痫合并早产合并低出生体重可能是由潜在的胎盘异常引起的，足月分娩的子痫前期可能是多种疾病的混合体，从轻度先兆子痫伴中度胎盘影响到无胎盘功能障碍的妊娠期高血压疾病。
Objectives The clinical characteristics of pre-eclampsia (gestational hypertension and proteinuria) may represent separate pathogenetic conditions. Pre-eclampsia accompanied by restricted fetal growth may originate from abnormal implantation, and appropriate or high birthweights may indicate a mixture of conditions, ranging from mild pre-eclampsia with modest placental involvement to hypertensive conditions without placental disease.Design Prospective, observational study.Setting General population.Population We used data from the Medical Birth Registry of Norway, a population-based registry that has recorded births since 1967. For this study, we used information on length of gestation and presence of pre-eclampsia among 1,679,205 singletons born between 1967 and 1998. Pre-eclampsia was diagnosed in 44,220 (2.6%) pregnancies.Methods We studied the risk of pre-eclampsia in relation to standardised measures (z scores) of birthweight, adjusted for length of gestation, and stratified by term and preterm delivery. We also explored whether gestational diabetes was more prevalent in conjunction with preterm than term pre-eclampsia.Main outcome measures Pre-eclampsia diagnosed at term or preterm.Results For pre-eclampsia diagnosed around term, there was a U-shaped association with birthweight. Compared with appropriate birthweights for gestation, the risk of term pre-eclampsia was more than fourfold higher (relative risk [RR] 4.5, 95% confidence interval [CI], 4.3 to 4.7) if the baby's birthweight was lower than two standard deviations under the mean. For birthweights three standard deviations or higher than the mean, pre-eclampsia was more than twice as likely (RR 2.6, 95% CI 2.2-2.9). In contrast, the risk of preterm pre-eclampsia displayed an L-shaped association, with birthweight. Low birthweight (less than -2 standard deviations) was associated with greatly increased risk (RR 9.9, 95% CI 9.1-10.9), but for high birthweights (greater than or equal to3 standard deviations), there was no association with the risk of preterm pre-eclampsia (RR 1.2, 95% CI 0.7-2.1). The prevalence of gestational diabetes was three times (prevalence ratio 3.3, 95% CI 2.6-3.6) higher in preterm than term pre-eclampsia.Conclusion Whereas pre-eclampsia with preterm delivery associated with low birthweight may be caused by underlying placental abnormality, pre-eclampsia delivered at term may represent a mixture of conditions, ranging from mild pre-eclampsia with moderate placental affection to hypertensive conditions in pregnancy without placental dysfunction.