Hypertensive Disorders in Pregnancy and Subsequently Measured Cardiovascular Risk Factors
Hypertensive Disorders in Pregnancy and Subsequently Measured Cardiovascular Risk Factors
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DOI：
10.1097/aog.0b013e3181bb0dfc
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发表时间：
2009-11-01
影响因子：
7.2
通讯作者：
Romundstad, Pal R.
中科院分区：
文献类型：
--
作者：
Magnussen, Elisabeth B.;Vatten, Lars J.;Romundstad, Pal R.
目的：研究妊娠期高血压疾病与心血管和代谢性疾病的可调性危险因素的关系，评估早期发现和预防的可行性。方法：这是一项前瞻性研究，研究对象为1967-1995年间首次生育独生子女的15065名妇女，她们后来参加了一项人群研究，包括标准化测量血压、血脂和体重指数(BMI)。结果：有妊娠期高血压疾病病史(先兆子痫或妊娠期高血压)的妇女BMI较高，血压较高，总胆固醇、低密度脂蛋白胆固醇和甘油三酯水平不良。先兆子痫与患糖尿病的风险显著增加(优势比3.8，95%可信区间[CI]2.1-6.6)，如果高血压疾病发生在一次以上的妊娠中，或者发生在相对较晚的妊娠中，与后来的心血管危险因素的关联要强得多。因此，与没有高血压病史的妇女相比，有两次先兆子痫发作的妇女在随访时使用降压药的可能性约为10倍(调整后的优势比，11.6，95%可信区间7.1-26.3)，在连续三次怀孕的妊娠期高血压妇女中，收缩压平均高27毫米汞(95%可信区间18-37毫米汞)，舒张压高12毫米汞(95%可信区间5-19毫米汞)。对当前体重指数的调整部分减弱了这些关联，表明BMI可能起着重要的中介作用。结论：有妊娠期高血压疾病病史的女性，特别是有反复妊娠障碍的女性，应该成为预防早产儿心血管疾病的干预对象。(Obstet Gyneol 2009；114：961-70)
OBJECTIVE: To study the association of hypertensive pregnancy disorders with modifiable risk factors for cardiovascular and metabolic diseases and to estimate the feasibility for early detection and prevention.METHODS: This was a prospective study of 15,065 women with a first singleton birth between 1967 and 1995, who later participated in a population study that included standardized measurements of blood pressure, serum lipids, and body mass index (BMI).RESULTS: Women with a history of hypertensive disorders in pregnancy (preeclampsia or gestational hypertension) had higher BMI, higher blood pressure, and unfavorable levels of total cholesterol, low-density lipoprotein cholesterol, and triglycerides. Preeclampsia was associated with substantially higher risk of developing diabetes (odds ratio 3.8, 95% confidence interval [CI] 2.1-6.6), and if the hypertensive disorder occurred in more than one pregnancy, or in a relatively late pregnancy, the associations with later cardiovascular risk factors were substantially stronger. Thus, women with two episodes of preeclampsia were approximately 10 times more likely to use blood pressure medication at follow-up (adjusted odds ratio, 11.6, 95% CI 7.1-26.3), and in women with gestational hypertension in three consecutive pregnancies, systolic pressure was on average 27 mm Hg (95% CI 18-37 mm Hg) higher, and diastolic pressure was 12 mm Hg (95% CI 5-19 mm Hg) higher, compared with women without a history of hypertensive disorders. Adjustment for current body mass index partly attenuated these associations, suggesting that BMI may play an important mediating role.CONCLUSION: Women with a history of hypertensive disorders in pregnancy, and particularly women with recurrent pregnancy disorders, should be candidates for intervention intended to prevent premature cardiovascular disease. (Obstet Gynecol 2009;114:961-70)